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General NPI Number Information
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NPI Number | 1790201523
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Entity Type | Organization
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Legal Business Name | ADVANCE HEALTH IPA, LLC
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14121 PARKE LONG CT STE 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 571-449-8962
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Fax |
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Provider Business Mailing Address
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Address Line | 14121 PARKE LONG CT STE 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 571-449-8962
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | MS. ALICIA J PALMER
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Credential |
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Telephone | 571-449-8962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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